Pub Date : 2024-06-04DOI: 10.1186/s41984-024-00299-0
Aly Ibrahim, Khaled Elshazly, Mohamed A. R. AbdelFatah, Abdelrahman El-Gayar, Sameh Hefny
Spontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities. This is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery. Surgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.
{"title":"Management of spontaneous pyogenic spondylodiscitis: a descriptive cohort study","authors":"Aly Ibrahim, Khaled Elshazly, Mohamed A. R. AbdelFatah, Abdelrahman El-Gayar, Sameh Hefny","doi":"10.1186/s41984-024-00299-0","DOIUrl":"https://doi.org/10.1186/s41984-024-00299-0","url":null,"abstract":"Spontaneous spondylodiscitis (SD) is an inflammation of the vertebral endplate and the intervertebral disc with no prior surgery or intervention. The treatment of spontaneous pyogenic SD mainly consists of systemic antibiotics and rest. Some cases require surgery due to failure of medical treatment or due to neurological compromise. Due to the disease heterogeneity, there are no standardized, widely adopted treatment protocols. We conducted this study to assess the clinical outcome of the different treatment modalities. This is a retrospective analysis of prospectively collected data of patients with spontaneous non-tuberculous spondylodiscitis. Thirty-eight patients were identified, including 14 males and 24 females. The mean age was 49 years. Twenty-three patients underwent surgery from the start while 15 patients received conservative medical treatment. Among the latter, 8 patients showed disease progression and required surgical intervention. The ODI/NDI at 1 year (mean = 8) was significantly better than before treatment (mean = 18). Among 11 patients with motor deficit at presentation, 8 improved and 3 remained stable. There were 14 complications, including 11 minor and 3 major, requiring one revision surgery. Surgical decompression and debridement with or without instrumented fusion for complicated SD cases is a safe and effective treatment modality. Close follow-up is needed in case of conservative treatment for early detection of treatment failure and disease progression. Baseline characteristic variabilities in patients with spontaneous pyogenic SD could predict conservative treatment failure, but this needs to be validated in larger series.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141252237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1186/s41984-024-00305-5
Andrew B. Yang, Fraser C. Henderson
<p>We read with interest the recently published retrospective cohort study “Giant invasive pituitary adenomas: surgical approach selection paradigm and its influence on the outcome—case series” by Dr. Saad, et al. highlighting the persistent role in the treatment algorithm for a transcranial approach for <i>giant</i> pituitary adenomas, as present frequently in our low-resource setting in rural Kenya. In our center, we have been learning firsthand the difficulties surrounding maximum safe resection of giant adenomas. We remain humbled by the reality of the challenges in decompressing the optic apparatus, minimizing tumor burden to prevent recurrence, preserving pituitary and hypothalamic functions, and stewarding patient resources in what can be a very expensive undertaking, even in charitable low- and middle-income country (LMIC) hospitals.</p><p>We are grateful to the authors for illustrating in the African setting the importance of including a transcranial approach in the treatment plan for many of these giant adenomas. Although the endonasal approach has become the widespread method of complete resection in many areas of the world over the past two decades, in sub-Saharan Africa, where pituitary adenomas are the second most common brain tumor, the endoscopic endonasal approach (EEA) was only adopted in our center about two years ago [1, 2]. EEA adoption in LMIC settings remains relatively lower in comparison with high-resource academic centers where the EEA continues to be refined to ever-higher heights of efficacy [2, 3].</p><p>We have come to better understand the reasons for this reticence in applying EEA to every pituitary adenoma. First, the learning curve for surgeons and assistants for the EEA can be steep, and adoption is more likely to occur at any given institution if that institution has staff who have been trained in the approach, to avoid postoperative complications like cerebrospinal fluid leaks and hypopituitarism [2,3,4]. Second, the capital resources required to purchase and maintain necessary endoscopic equipment and to train individuals on its use and handling are high [3]. Third is the fact that pituitary tumors tend to present later in their course in LMIC due to a variety of social and economic factors [5]. This means that tumors tend to be larger, of a firmer consistency, and more densely adherent to critical structures such as the Circle of Willis and the pituitary gland and hypothalamus by the time a neurosurgeon becomes involved. Fourth is the significant expense of MRI facilities and intraoperative navigation leading to a dearth of these capabilities in sub-Saharan Africa [6].</p><p>To illustrate one of our humbling experiences, we reference a recent case of a 50-year-old woman who presented to an eye clinic with 5 years of progressive bilateral visual deficits and was referred to our neurosurgery clinic. She arrived to us 11 months later with complete right eye blindness and the ability to count fingers up to 1 m a
我们饶有兴趣地阅读了萨阿德博士等人最近发表的回顾性队列研究《巨大侵袭性垂体腺瘤：手术方式选择范例及其对结果的影响--病例系列》，该研究强调了经颅途径治疗巨大垂体腺瘤在治疗算法中的持续作用，这种情况在我们肯尼亚农村的低资源环境中经常出现。在我们中心，我们亲身体会到了最大限度安全切除巨大腺瘤的困难。即使是在中低收入国家（LMIC）的慈善医院中，减压视神经器、尽量减少肿瘤负担以防止复发、保留垂体和下丘脑功能以及管理患者资源都可能是一项非常昂贵的工作，这些现实挑战令我们深感惭愧。尽管过去二十年来，内窥镜方法已成为世界上许多地区广泛采用的完整切除方法，但在撒哈拉以南非洲地区，垂体腺瘤是第二大常见脑肿瘤，我们中心大约两年前才开始采用内窥镜内窥镜方法（EEA）[1, 2]。与资源丰富的学术中心相比，EEA 在低收入、中等收入国家和地区的采用率仍然相对较低，而在这些国家和地区，EEA 的疗效不断提高[2, 3]。首先，外科医生和助手对 EEA 的学习曲线可能很陡峭，如果某个机构的员工接受过该方法的培训，那么该机构就更有可能采用该方法，以避免脑脊液漏和垂体功能减退等术后并发症[2,3,4]。其次，购买和维护必要的内窥镜设备以及对个人进行使用和操作培训所需的资金资源很高[3]。第三，在低收入国家，由于各种社会和经济因素，垂体瘤的发病时间往往较晚[5]。这意味着当神经外科医生介入时，肿瘤往往更大、更坚硬、更密集地附着在重要结构上，如威利斯环、垂体和下丘脑。第四，核磁共振成像设施和术中导航的费用高昂，导致撒哈拉以南非洲地区缺乏这些能力[6]。为了说明我们的一次令人惭愧的经历，我们引用了最近的一个病例：一名 50 岁的妇女因 5 年的进行性双侧视力障碍到眼科诊所就诊，并被转诊到我们的神经外科诊所。11 个月后，她来到我们这里，右眼完全失明，左眼能够数到 1 米以外的手指，CT 扫描对比发现她患有巨大垂体腺瘤（图 1）。在该患者中，由于肿瘤向右侧颈动脉外侧延伸，我们采用了右侧额颞侧或眶内经颅入路，而不是鼻内入路，这也是我们希望将患者的费用从两次手术降至一次手术的原因之一。然而，由于纤维瘤非常坚硬，而且我们没有超声波吸引器，因此无法安全地进行完全切除。因此，我们证实了 Saad 博士等人的研究结果，即较大、侵袭性较强的肿瘤往往具有较难切除的稠度，导致部分切除率和复发率较高[7]。根据我们在肯尼亚西部农村地区一家神经外科中心的经验，我们发现萨阿德博士等人就巨大垂体腺瘤提出的许多观点都是正确的，这些观点支持将经颅方法牢牢地保留在武器库中，以补充或有时取代 EEA。我们同意，在许多情况下，患者应同意采用两阶段方法，但具有讽刺意味的是，需要进行资源密集型治疗的往往是那些已经存在固定缺陷、最无力负担医疗费用的患者。此外，我们所处的低收入和中等收入国家还面临着一系列社会经济方面的挑战，无法将 EEA 作为一种独立的方法常规使用。 这些挑战在世界各地的低收入和中等收入国家都面临着，我们感谢大家关注在低收入和中等收入国家进行手术的神经外科医生所面临的这一长期挑战，因为这些国家经常出现巨大腺瘤。2021;149:e329-35.Article PubMed Google Scholar Balogun JA, Daniel A, Idowu OK.驾驭巨大肿瘤的学习曲线：内镜下鼻内镜经鼻切除 PitNETs 的初步经验。J Clin Neurosci.2023;112:6-11.Article CAS PubMed Google Scholar Younus I, et al. The slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries.Acta Neurochir (Wien).2020;162(10):2361-70.Article PubMed Google Scholar Kanwaljeet Garg BC, Pahwa B, Arnaout MM, Zenonos GA, Piloto OL, Fontanella MM, Schwartz TH.ellar/Parasellar病变微创方法扩散的地域差异。2022;168:e162-77.Article Google Scholar Sharma V, et al. 发展中国家癌症控制的挑战：现状与未来展望。Future Oncol.2011;7(10):1213-22.Article PubMed Google Scholar Ogbole GI, et al. Survey of magnetic resonance imaging availability in West Africa.Pan Afr Med J. 2018;30:240.Article PubMed PubMed Central Google Scholar Rutkowski MJ, et al. Development and clinical validation of a grading system for pituitary adenoma consistency.J Neurosurg. 2020;134(6):1800-7.Article PubMed Google Scholar Download referencesNot applicableThere was no funding involved in the writing of this letter.Authors and AffiliationsWeill Cornell Medical College, New York, NY, USAAndrew B. YangTenwek Hospital, Bomet County, KenyaFraser C. Henderson JrAuthors.Henderson Jr作者简介Andrew B. Yang查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者Fraser C. Henderson Jr查看作者发表的论文您也可以在PubMed Google Scholar中搜索该作者供稿AY撰写了这封信的草稿。FH 在信中提供了指导并监督了对患者的护理。通讯作者：Fraser C. Henderson Jr.伦理批准和参与同意书不适用.发表同意书已获得信中所有受试者的知情同意.利益冲突作者声明他们没有利益冲突.出版商注释施普林格-自然（Springer Nature）对出版地图中的管辖权主张和机构隶属关系保持中立.出版商注释施普林格-自然（Springer Nature）对出版地图中的管辖权主张和机构隶属关系保持中立.出版商注释施普林格-自然（Springer Nature）对出版地图中的管辖权主张和机构隶属关系保持中立.开放获取本文采用知识共享署名 4.0 国际许可协议，该协议允许以任何媒介或格式使用、共享、改编、分发和复制本文，但必须注明原作者和出处，提供知识共享许可协议的链接，并说明是否进行了修改。
{"title":"Letter to the editor: additional considerations for giant pituitary adenoma resection strategy","authors":"Andrew B. Yang, Fraser C. Henderson","doi":"10.1186/s41984-024-00305-5","DOIUrl":"https://doi.org/10.1186/s41984-024-00305-5","url":null,"abstract":"<p>We read with interest the recently published retrospective cohort study “Giant invasive pituitary adenomas: surgical approach selection paradigm and its influence on the outcome—case series” by Dr. Saad, et al. highlighting the persistent role in the treatment algorithm for a transcranial approach for <i>giant</i> pituitary adenomas, as present frequently in our low-resource setting in rural Kenya. In our center, we have been learning firsthand the difficulties surrounding maximum safe resection of giant adenomas. We remain humbled by the reality of the challenges in decompressing the optic apparatus, minimizing tumor burden to prevent recurrence, preserving pituitary and hypothalamic functions, and stewarding patient resources in what can be a very expensive undertaking, even in charitable low- and middle-income country (LMIC) hospitals.</p><p>We are grateful to the authors for illustrating in the African setting the importance of including a transcranial approach in the treatment plan for many of these giant adenomas. Although the endonasal approach has become the widespread method of complete resection in many areas of the world over the past two decades, in sub-Saharan Africa, where pituitary adenomas are the second most common brain tumor, the endoscopic endonasal approach (EEA) was only adopted in our center about two years ago [1, 2]. EEA adoption in LMIC settings remains relatively lower in comparison with high-resource academic centers where the EEA continues to be refined to ever-higher heights of efficacy [2, 3].</p><p>We have come to better understand the reasons for this reticence in applying EEA to every pituitary adenoma. First, the learning curve for surgeons and assistants for the EEA can be steep, and adoption is more likely to occur at any given institution if that institution has staff who have been trained in the approach, to avoid postoperative complications like cerebrospinal fluid leaks and hypopituitarism [2,3,4]. Second, the capital resources required to purchase and maintain necessary endoscopic equipment and to train individuals on its use and handling are high [3]. Third is the fact that pituitary tumors tend to present later in their course in LMIC due to a variety of social and economic factors [5]. This means that tumors tend to be larger, of a firmer consistency, and more densely adherent to critical structures such as the Circle of Willis and the pituitary gland and hypothalamus by the time a neurosurgeon becomes involved. Fourth is the significant expense of MRI facilities and intraoperative navigation leading to a dearth of these capabilities in sub-Saharan Africa [6].</p><p>To illustrate one of our humbling experiences, we reference a recent case of a 50-year-old woman who presented to an eye clinic with 5 years of progressive bilateral visual deficits and was referred to our neurosurgery clinic. She arrived to us 11 months later with complete right eye blindness and the ability to count fingers up to 1 m a","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-28DOI: 10.1186/s41984-024-00304-6
Ahmed Jribi, Fatma Dhouib, Wicem Siala, Nejla Fourati, Jamel Daoud
Cerebellar liponeurocytoma is a rare benign tumor of the central nervous system affecting adults and mainly the posterior fossa. Its positive diagnosis remains difficult due to its rarity and the presence of several differential diagnoses including medulloblastoma. The oncogenetic mechanism, the therapeutic modalities and results are still currently under study. Very few cases have been published in the literature. The aim of this review is to report, through the available data, all its various clinico-epidemiological, pathological, radiological, genetic, therapeutic and evolutionary features. In fact, this tumor is associated with a slow-growing character, appears in young adulthood with slight female predominance and is often manifested by intracranial hypertension symptoms. It is pathologically characterized by a focal component of lipomatous differentiation and a low proliferation index. It is usually presented in imaging by a well-limited mass with signal attenuation for fatty tissue and heterogeneous contrast. No mutation has been identified yet. The gold standard treatment of this tumor is maximal complete resection. The evolutionary profile is marked by frequent local recurrence. Radiotherapy could be discussed in case of recurrence, incomplete surgery, inoperable cases and cases with high proliferation index, and there is to date no proof of benefit for systemic treatment. Due to the numerous similarities of this entity with medulloblastoma, it should be always evoked face to any suspicion of medulloblastoma in adults in order to avoid a wrong overtreatment.
{"title":"Cerebellar liponeurocytoma: clinico-epidemiological, pathological, radiological, genetic, therapeutic and evolutionary characteristics—a review of the literature","authors":"Ahmed Jribi, Fatma Dhouib, Wicem Siala, Nejla Fourati, Jamel Daoud","doi":"10.1186/s41984-024-00304-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00304-6","url":null,"abstract":"Cerebellar liponeurocytoma is a rare benign tumor of the central nervous system affecting adults and mainly the posterior fossa. Its positive diagnosis remains difficult due to its rarity and the presence of several differential diagnoses including medulloblastoma. The oncogenetic mechanism, the therapeutic modalities and results are still currently under study. Very few cases have been published in the literature. The aim of this review is to report, through the available data, all its various clinico-epidemiological, pathological, radiological, genetic, therapeutic and evolutionary features. In fact, this tumor is associated with a slow-growing character, appears in young adulthood with slight female predominance and is often manifested by intracranial hypertension symptoms. It is pathologically characterized by a focal component of lipomatous differentiation and a low proliferation index. It is usually presented in imaging by a well-limited mass with signal attenuation for fatty tissue and heterogeneous contrast. No mutation has been identified yet. The gold standard treatment of this tumor is maximal complete resection. The evolutionary profile is marked by frequent local recurrence. Radiotherapy could be discussed in case of recurrence, incomplete surgery, inoperable cases and cases with high proliferation index, and there is to date no proof of benefit for systemic treatment. Due to the numerous similarities of this entity with medulloblastoma, it should be always evoked face to any suspicion of medulloblastoma in adults in order to avoid a wrong overtreatment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-28DOI: 10.1186/s41984-024-00297-2
Mohammud Ahmud Salim, Hossam Elnoamany, Mohammed Adel Dorrah, Zahraa M. Mahdy, Ahmed Said Mansour
Benign peripheral nerve sheath tumors (BPNSTs) include schwannomas and neurofibromas. About 10% of soft tissue sarcomas are malignant peripheral nerve sheath tumors (MPNSTs), which are invasive and aggressive tumors. These can happen occasionally or after radiation exposure. Up to 90% of schwannomas are made up of differentiated neoplastic Schwann cells. Malignant transformation of schwannomas is rare. We collected the medical records of all patients (including their family histories), performed comprehensive physical and neurological assessments, and checked for the presence of a Tinel-like sign, as well as screening for neurofibromatosis (NF) signs. Magnetic resonance imaging (MRI), nerve conduction studies, and ultrasound were done for all cases. We have operated on 21 patients with age range 29–52 years. The mean age was 39.4 years. 14 of these patients were females and 7 were males. The presenting symptoms were just swelling at nerve site in 14 patients, spontaneous pain at the nerve sites in 7 patients, and sensory deficit at the nerve distribution sites in 9 patients. The other 12 patients were sensory intact and only 7 patients had motor deficit. Postoperatively all patients had improved motor and sensory deficit and none of intact patients were worsened. Preoperatively we did MRI to show important nearby vascular structure anatomical abnormalities and we ordered nerve studies to all patients that showed abnormalities, which was only in 9 patients. Gross total resection was done in 18 patients and other 3 cases had partial resection to avoid sensory and motor deficits. The pathological analysis revealed 11 schwannomas and 10 neurofibromas. With 1 year follow up there was no recurrence in any patients. Benign pheripheral nerve sheath tumours are safely resected without increased sensory and motor deficits after surgery and with improve clinical outcome with no recurrence on follow up.
{"title":"Surgical outcome of isolated benign peripheral nerve sheath tumors without neurofibromatosis","authors":"Mohammud Ahmud Salim, Hossam Elnoamany, Mohammed Adel Dorrah, Zahraa M. Mahdy, Ahmed Said Mansour","doi":"10.1186/s41984-024-00297-2","DOIUrl":"https://doi.org/10.1186/s41984-024-00297-2","url":null,"abstract":"Benign peripheral nerve sheath tumors (BPNSTs) include schwannomas and neurofibromas. About 10% of soft tissue sarcomas are malignant peripheral nerve sheath tumors (MPNSTs), which are invasive and aggressive tumors. These can happen occasionally or after radiation exposure. Up to 90% of schwannomas are made up of differentiated neoplastic Schwann cells. Malignant transformation of schwannomas is rare. We collected the medical records of all patients (including their family histories), performed comprehensive physical and neurological assessments, and checked for the presence of a Tinel-like sign, as well as screening for neurofibromatosis (NF) signs. Magnetic resonance imaging (MRI), nerve conduction studies, and ultrasound were done for all cases. We have operated on 21 patients with age range 29–52 years. The mean age was 39.4 years. 14 of these patients were females and 7 were males. The presenting symptoms were just swelling at nerve site in 14 patients, spontaneous pain at the nerve sites in 7 patients, and sensory deficit at the nerve distribution sites in 9 patients. The other 12 patients were sensory intact and only 7 patients had motor deficit. Postoperatively all patients had improved motor and sensory deficit and none of intact patients were worsened. Preoperatively we did MRI to show important nearby vascular structure anatomical abnormalities and we ordered nerve studies to all patients that showed abnormalities, which was only in 9 patients. Gross total resection was done in 18 patients and other 3 cases had partial resection to avoid sensory and motor deficits. The pathological analysis revealed 11 schwannomas and 10 neurofibromas. With 1 year follow up there was no recurrence in any patients. Benign pheripheral nerve sheath tumours are safely resected without increased sensory and motor deficits after surgery and with improve clinical outcome with no recurrence on follow up.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-27DOI: 10.1186/s41984-024-00300-w
Yao Christian Hugues Dokponou, Moussa Elmi Saad, Fresnel Lutece Ontsi Obame, Napoleão Imbunhe, Salami Mohcine, Abad Cherif El Asri, Miloud Gazzaz
Cavernous malformations can occur throughout the cerebral nervous system, most commonly located in the supratentorial compartment. The intramedullary location is rare and accounts for approximately 2.4% to 5% of all spinal vascular tumors. The cervical cord location and its clinical manifestations are underreported. The authors report a case of spinal cord compression at the C5–C6 level by a cervical intramedullary cavernoma with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Relevant studies (1980 to 2023) that reported patients with cervical intramedullary cavernoma were identified from PubMed databases. A total of 29 studies reporting 423 patients were included in this study with a mean age of 40.5 ± 6.3 years old. The overall male-to-female ratio was 1:2.5 with a median duration of follow-up of 46 months [18.5–63.9]. The type of resection as well as the patient’s outcome was also reported. Intramedullary cavernous angiomas are rare. Early surgical total resection of the symptomatic lesions in adequate conditions is crucial for good outcomes.
{"title":"Surgical management of cervical intramedullary cavernoma: case report and systematic review of the literature","authors":"Yao Christian Hugues Dokponou, Moussa Elmi Saad, Fresnel Lutece Ontsi Obame, Napoleão Imbunhe, Salami Mohcine, Abad Cherif El Asri, Miloud Gazzaz","doi":"10.1186/s41984-024-00300-w","DOIUrl":"https://doi.org/10.1186/s41984-024-00300-w","url":null,"abstract":"Cavernous malformations can occur throughout the cerebral nervous system, most commonly located in the supratentorial compartment. The intramedullary location is rare and accounts for approximately 2.4% to 5% of all spinal vascular tumors. The cervical cord location and its clinical manifestations are underreported. The authors report a case of spinal cord compression at the C5–C6 level by a cervical intramedullary cavernoma with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and meta-analysis guidelines. Relevant studies (1980 to 2023) that reported patients with cervical intramedullary cavernoma were identified from PubMed databases. A total of 29 studies reporting 423 patients were included in this study with a mean age of 40.5 ± 6.3 years old. The overall male-to-female ratio was 1:2.5 with a median duration of follow-up of 46 months [18.5–63.9]. The type of resection as well as the patient’s outcome was also reported. Intramedullary cavernous angiomas are rare. Early surgical total resection of the symptomatic lesions in adequate conditions is crucial for good outcomes.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141168487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Neurosurgical management of older patients is very complex and delicate; efforts are being made in identifying groups of older patients at risk of poor surgical outcomes before the surgery, making frailty an important concept in risk Identification and postoperative outcome assessment of older patients in the ever-changing neurosurgical world. It's of great importance for the concept of frailty to be adopted in Africa's neurosurgical practice in other to optimize the outcomes and improve the efficiency of neurosurgery in the older patients whose population is expanding, forming a great quota of people using neurosurgical services in Africa. This article looks into the importance and challenges of frailty studies in African neurosurgical practice which mainly are the longer length of time in carrying out such studies; reduces manpower, lack of availability of specialized equipment in standardizing the assessment, and others; makes recommendations on ways to ease its adoption such as funding frailty research and creation of population-specific frailty assessment tools among others.
{"title":"Frailty concept in Africa neurosurgical practice: a prospective review","authors":"Kehinde Alare, Habiblah Jagunmolu, Esther Adewuyi, Taiwo Oluwafemi, Peter Olaniyi, Precious Amuzat","doi":"10.1186/s41984-024-00284-7","DOIUrl":"https://doi.org/10.1186/s41984-024-00284-7","url":null,"abstract":"Neurosurgical management of older patients is very complex and delicate; efforts are being made in identifying groups of older patients at risk of poor surgical outcomes before the surgery, making frailty an important concept in risk Identification and postoperative outcome assessment of older patients in the ever-changing neurosurgical world. It's of great importance for the concept of frailty to be adopted in Africa's neurosurgical practice in other to optimize the outcomes and improve the efficiency of neurosurgery in the older patients whose population is expanding, forming a great quota of people using neurosurgical services in Africa. This article looks into the importance and challenges of frailty studies in African neurosurgical practice which mainly are the longer length of time in carrying out such studies; reduces manpower, lack of availability of specialized equipment in standardizing the assessment, and others; makes recommendations on ways to ease its adoption such as funding frailty research and creation of population-specific frailty assessment tools among others.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140928266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1186/s41984-024-00290-9
Patrick Murithi Kaberia, Ahmed Hafez Farhoud, Mahmoud Abbassy, Anwar Hamed Heikal, Ahmed AbdelAziz Fayed
Insular gliomas’ management challenges are attributed to their complex shape, proximity to critical vasculature, and organization. However, cytoreductive surgery's role in maximal extent of resection (EOR) improves survival. Intraoperative ultrasound (IOUS) aids in defining tumor border, detecting residual, and guiding access. The aim of this study was to assess the impact of using intraoperative ultrasound on the extent of resection of insular gliomas, and the postoperative outcomes in a prospective cohort of 20 patients operated at Alexandria main university hospital and followed up for a period of at least 3 months. The Near total resection rate was 45% with 70% of patients having no neurological morbidity postoperatively. The median EOR was 81% with a range of 44 to 96%. The mean duration of IOUS setup was 19.6 ± 5.04 min, while the additional resection rate following IOUS assessment for residual tumor was 65% (n = 13). In addition, there was a significant increase in Karnofsky Performance Status (KPS) from the preoperative through to the 90-day follow-up period (p = 0.012). Finally, following multivariate linear regression analysis, the EOR was identified as having a statistically significant correlation with the postoperative KPS (p = 0.004). Intraoperative ultrasonography is a valuable modality for strategizing the most efficient route to the tumor, promptly detecting any remaining tumor tissue, and optimizing the extent of resection for insular gliomas, while taking into consideration the phenomenon of brain shift.
{"title":"Ultrasound-assisted resection of insular gliomas","authors":"Patrick Murithi Kaberia, Ahmed Hafez Farhoud, Mahmoud Abbassy, Anwar Hamed Heikal, Ahmed AbdelAziz Fayed","doi":"10.1186/s41984-024-00290-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00290-9","url":null,"abstract":"Insular gliomas’ management challenges are attributed to their complex shape, proximity to critical vasculature, and organization. However, cytoreductive surgery's role in maximal extent of resection (EOR) improves survival. Intraoperative ultrasound (IOUS) aids in defining tumor border, detecting residual, and guiding access. The aim of this study was to assess the impact of using intraoperative ultrasound on the extent of resection of insular gliomas, and the postoperative outcomes in a prospective cohort of 20 patients operated at Alexandria main university hospital and followed up for a period of at least 3 months. The Near total resection rate was 45% with 70% of patients having no neurological morbidity postoperatively. The median EOR was 81% with a range of 44 to 96%. The mean duration of IOUS setup was 19.6 ± 5.04 min, while the additional resection rate following IOUS assessment for residual tumor was 65% (n = 13). In addition, there was a significant increase in Karnofsky Performance Status (KPS) from the preoperative through to the 90-day follow-up period (p = 0.012). Finally, following multivariate linear regression analysis, the EOR was identified as having a statistically significant correlation with the postoperative KPS (p = 0.004). Intraoperative ultrasonography is a valuable modality for strategizing the most efficient route to the tumor, promptly detecting any remaining tumor tissue, and optimizing the extent of resection for insular gliomas, while taking into consideration the phenomenon of brain shift.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140883084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-02DOI: 10.1186/s41984-024-00282-9
William A. Florez-Perdomo, Andrés Cardona-Cruz Guillermo, Ezequiel García-Ballestas, Abigail Castilla-Martínez, Yancarlos Ramos-Villegas, Loraine Quintana-Pájaro, Tariq Janjua, Amit Agrawal, Luis Rafael Moscote-Salazar
Traumatic spinal cord injury (SCI) or traumatic myelopathy is a devastating neurological condition and a heavy burden on the health system. There are inflammatory and structural biomarkers with well-defined profiles, and useful for determining the management and prognosis of this pathology. Laboratory studies have shown some utility in confirming the existence of a spinal cord injury. Little knowledge about the molecular processes that occur after a SCI is evident, and it is well known that its understanding is dispensable to establish therapeutic targets that improve the outcomes for this type of patient. Many studies have explored the role of structural and inflammatory markers and some structural and inflammatory biomarkers. In the present article, we review the ongoing research in the field of spinal injury and possible role of biomarkers in the management of these patients.
{"title":"Pathobiology of traumatic spinal cord injury: an overview","authors":"William A. Florez-Perdomo, Andrés Cardona-Cruz Guillermo, Ezequiel García-Ballestas, Abigail Castilla-Martínez, Yancarlos Ramos-Villegas, Loraine Quintana-Pájaro, Tariq Janjua, Amit Agrawal, Luis Rafael Moscote-Salazar","doi":"10.1186/s41984-024-00282-9","DOIUrl":"https://doi.org/10.1186/s41984-024-00282-9","url":null,"abstract":"Traumatic spinal cord injury (SCI) or traumatic myelopathy is a devastating neurological condition and a heavy burden on the health system. There are inflammatory and structural biomarkers with well-defined profiles, and useful for determining the management and prognosis of this pathology. Laboratory studies have shown some utility in confirming the existence of a spinal cord injury. Little knowledge about the molecular processes that occur after a SCI is evident, and it is well known that its understanding is dispensable to establish therapeutic targets that improve the outcomes for this type of patient. Many studies have explored the role of structural and inflammatory markers and some structural and inflammatory biomarkers. In the present article, we review the ongoing research in the field of spinal injury and possible role of biomarkers in the management of these patients.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-02DOI: 10.1186/s41984-024-00264-x
Ahmet Cemil Ergün, Bilal Ertuğrul, Gökhan Yildirim, Metin Kaplan
Chiari syndrome is a very rare cause of secondary trigeminal neuralgia (TN). There are a few cases of TN associated with Chiari syndrome in the literature, and all of these cases were reported as Chiari type 1. In this report, we present a case of secondary trigeminal neuralgia caused by Chiari type 1.5 for the first time unlike the literature. A 38-year-old male patient, who had frequent and severe attacks of pain under the orbit, at the chin and rim of the mouth, was evaluated with craniocervical Magnetic Resonance Imaging (MRI) and revealed Chiari type 1.5 malformation and syringomyelia. The mechanism of TN associated with Chiari malformation is unclear. However, the main concepts emphasized in cases presented in the literature are compression and stretching. The rapid relief of pain after decompression surgery in these cases also supports this situation. It can be predicted that compression and tension forces will become more pronounced in Chiari type 1.5 malformation, in which the brainstem elongation and ventral pressure are more prominent. Decompression of the foramen magnum provides rapid and effective pain control in the treatment of TN accompanying Chiari 1.5 syndrome that does not respond to medical treatment.
{"title":"Chiari type 1.5 malformation as a cause of secondary trigeminal neuralgia: case report and literature discussion","authors":"Ahmet Cemil Ergün, Bilal Ertuğrul, Gökhan Yildirim, Metin Kaplan","doi":"10.1186/s41984-024-00264-x","DOIUrl":"https://doi.org/10.1186/s41984-024-00264-x","url":null,"abstract":"Chiari syndrome is a very rare cause of secondary trigeminal neuralgia (TN). There are a few cases of TN associated with Chiari syndrome in the literature, and all of these cases were reported as Chiari type 1. In this report, we present a case of secondary trigeminal neuralgia caused by Chiari type 1.5 for the first time unlike the literature. A 38-year-old male patient, who had frequent and severe attacks of pain under the orbit, at the chin and rim of the mouth, was evaluated with craniocervical Magnetic Resonance Imaging (MRI) and revealed Chiari type 1.5 malformation and syringomyelia. The mechanism of TN associated with Chiari malformation is unclear. However, the main concepts emphasized in cases presented in the literature are compression and stretching. The rapid relief of pain after decompression surgery in these cases also supports this situation. It can be predicted that compression and tension forces will become more pronounced in Chiari type 1.5 malformation, in which the brainstem elongation and ventral pressure are more prominent. Decompression of the foramen magnum provides rapid and effective pain control in the treatment of TN accompanying Chiari 1.5 syndrome that does not respond to medical treatment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140837770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1186/s41984-024-00285-6
Mesi Mathew, Isaac Gundu, Afeez Ajibade Aruna, Samuel Isa Gana, Muhammad Raji Mahmud, Abdullahi Onimisi Jimoh
Ghost tumors spontaneously disappear or decrease to less than 70% before definitive diagnosis and treatment (other than steroid treatment). We report our experience with a patient who had not received steroids, and the challenges of managing a ghost tumor from a developing country. A 71 year old female with frontal mass, right proptosis, and frontal headache. Mass was confirmed by cranial CT scan but entirely resolved while the patient was awaiting surgery. Further follow-up at 6 months revealed clinical and MRI evidence of recurrence. Ghost tumors are no myths and can recur! It is imperative to closely follow up with patients who have complete resolution of brain tumors prior to definitive treatment.
{"title":"Frontal ghost tumour: a case report","authors":"Mesi Mathew, Isaac Gundu, Afeez Ajibade Aruna, Samuel Isa Gana, Muhammad Raji Mahmud, Abdullahi Onimisi Jimoh","doi":"10.1186/s41984-024-00285-6","DOIUrl":"https://doi.org/10.1186/s41984-024-00285-6","url":null,"abstract":"Ghost tumors spontaneously disappear or decrease to less than 70% before definitive diagnosis and treatment (other than steroid treatment). We report our experience with a patient who had not received steroids, and the challenges of managing a ghost tumor from a developing country. A 71 year old female with frontal mass, right proptosis, and frontal headache. Mass was confirmed by cranial CT scan but entirely resolved while the patient was awaiting surgery. Further follow-up at 6 months revealed clinical and MRI evidence of recurrence. Ghost tumors are no myths and can recur! It is imperative to closely follow up with patients who have complete resolution of brain tumors prior to definitive treatment.","PeriodicalId":72881,"journal":{"name":"Egyptian journal of neurosurgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140615197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：